Pethidine for Pain Relief in Labour

Pethidine is a widely used drug for pain relief in labour. Pethidine is a similar drug to morphine and heroin. These three drugs are from a family of drugs known as opioids. Opioids basically are morphine-like drugs. Morphine is a natural drug that can be extracted from the opium poppy, where as pethidine is synthetically made. Pethidine was first used in Germany in 1940 to reduce pain in labour and its use has continued to the present day. Initially when pethidine was created, it was thought to be non addictive but we now know that this is not true.

Pethidine works my mimicking the effects of endorphins - the body’s own morphine-like substances. One of the functions of endorphins is to act as the body’s natural pain killer. Pethidine (like endorphins) attaches to special sites on the outside of nerve cells. These sites are known as opioids receptors. Once pethidine attaches to these receptors, a chain of events occurs that results in the depression of normal activity for a little while. Pethidine’s effects are far more dramatic than endorphins. The effects pethidine has on a woman’s body can readily observed after it has been administered. A woman may become dizzy, drowsy, her eyes may change in appearance and she may experience an altered level of perception of events around her. Pethidine acts on the central nervous system by inhibiting the pain signals that are sent to the brain. The subsequent result can reduce the pain experienced by the woman in labour. Pethidine can also increase the amount of pain a woman can tolerate.

How is pethidine given to a woman when she is in labour?

The most common way that pethidine is give to a woman in labour is by an injection into the muscle (usually into the thigh or buttock). Occasional pethidine is given into a vein via a drip. Pethidine usually has to be ordered by a doctor, but is then given by a midwife. The dosage a woman receives in labour varies, usually ranging from 50mg to 100mg. The total volume injected into the muscle is one to two millilitres.

How long does pethidine work for?

If pethidine is given via an injection into the muscle, it usually takes around ten to twenty minutes to begin working. Pethidine’s effects, when given by this method, last two to three hours. If pethidine is given directly into a vein via a drip, the effects are a lot more rapid. Pethidine begins working within two to three minutes. When pethidine is given via a vein it enters the blood stream directly and only takes a couple minutes to circulate around the entire body, therefore pethidine reaches the brain and the nerve sites rapidly. The problem with giving pethidine directly into a vein is even though the effects are rapid, they only last for a short time. The effects of pethidine injected into a muscle last a lot longer.

Will pethidine provide me with adequate pain relief while I am in labour?

This is not an easy question to answer as women report varying responses to pethidine. Some women say that it provides adequate relief while other women say they achieved no pain relief whatsoever (48% of women in one survey said this). Women report pethidine provides greater relief in early labour rather than in later labour (when the contractions are a lot stronger). The bigger the dose of pethidine, the more effective the pain relief. But the bigger the dose, the more side effects a woman and her baby may experience. One piece of research said that pethidine does not provide adequate pain relief during labour, but ends up heavily sedating the woman. Overall pethidine may reduce pain experienced during labour in some women. If a woman is tired, pethidine can provide sedation (and sometimes much needed sleep). Pethidine can act as a muscle relaxant which can in some cases result in faster dilation (opening) of the cervix.

What are the disadvantages of using pethidine for pain relief in labour?

Pethidine may not provide adequate pain relief for some women. Nausea and vomiting are common, a medication may be mixed with the pethidine to help reduce these effects. Some women report feeling drowsy and confused. The effects pethidine has on perception may make the contractions difficult to deal with. Other potential side effects for the woman in labour include difficulty passing urine, dry mouth, hallucinations, respiratory depression, low blood pressure and allergic reaction .

There are no advantages to the baby if the mother has pethidine. Pethidine is known to cross the placenta and is present in breastmilk. The major problem for the baby is that pethidine can cause breathing difficulties after birth due to its depressive effect on the baby’s respiratory centre. These effects are at the worse if the baby is born one to three hours after an injection of pethidine has been given. This is the reason that pethidine is ideally avoided when the birth is perceived to be close. An antidote can be given to the baby to reverse the effects of pethidine, however the effects of the antidote only last a short time and when they wear off the baby may re-experience breathing problems. Baby’s are more likely to have jaundice if their mothers have pethidine. Pethidine effects the baby’s sucking reflex and can cause breastfeeding difficulties for the first few days. Baby’s may require special care or neonatal intensive care from the effects of pethidine, resulting in separation of mother and baby.

Jane Palmer is a mother, birth activist and midwife in private practice located in Sydney, Australia. With additional qualifications as a childbirth educator and lactation consultant, Jane works to improve pregnancy, birth and parenting options for families.

Pethidine interferes with the baby's sucking reflexes in the early days after birth. Sucking is critical in helping establish a good supply of breast milk. The Australian Breastfeeding Association have a good article on ways in increase your breastmilk supply. To see the article.

I had pethidine when I gave birth to my first child 4 months ago. I have just read this article and am leaving a comment to say that I didn't experience any negative side effects. I had pethidine and then gas during my 6 hour labour - pethidine helped me a lot and gas didn't seem to have any effect at all! My contractions didn't start after my waters broke, so they had to be induced and I went from zero to 10 cms dilated in just 3 hours. Pethidine helped relax me in between contractions - so much so, I started cracking jokes (for a short while anyway).
For 'Neerja' re. low milk production: talk to your doctor. You may be prescribed 'Motilium' also called 'Domperidone'. This is effective in getting your breastmilk up.

I gave birth last week. I was induced at midnight and by 5am was well on my way and pretty close to fully dilated. I was expecting a very big baby so epidural wasn't an option, so I have gas and pethidine. Kayla scored well on her Apgar test, was a bit slow on the uptake but they gave her the antidote and she recovered fully within a brief moment and is a beautiful healthy baby. Not the biggest fan of having to work for her milk, but doesn't have a problem latching at all - she latched within minutes of birth. Must say my only side effect has been that my butt is so sore where the injection was given...

I had pethidine very close to the time of my baby's birth. My child is now 10. He has always had respiratory problems. When he gets a cold he has an asthma sounding cough for at least a week. I am constantly told that it is not asthma it is just a virus. My gut feeling is that it had something to do with the pethidine or the Narcan that he needed to reverse the effects of the pethidine. Could I be right and what can I do for him?

Hi Susan - Research into the long term effects of pain relief in labour has not been carried out. So the answer is we just don't know what effects it can have. Have you thought about seeing a complementary therapist such as a naturopath, oesteopath, acuptucurist or similar? They may be able to offer some alternative ideas on how to manage your sons respiratory problems.

Hi my son is now 8 yrs old and just like susan,jun 20 2011. my son has symtoms of asthma when he gets a cold ,,i was given the pethidine 100mg 30mins before giving birth ...when he was born he did not cry-out..and was given the narcan...same anti-eating symtoms for the next few days...my son is fine now very athletic ,,but the wheezing is present sometimes...does the pethidine have any long term effects or can it hamper whith a new born babys brain developement..

Hello, I also used pethidine, i have never had problems with my son jett and he is 9 months old now, but what i want to say is that i had no idea about these side affects, and the point i wanna make is i think they should warn us before offering it. i had no idea!
if they had told me about the side affects i would have said NO!

Hi, I had pethidine about 3 hours before I gave birth. I only resorted to it after a 27 hour labour, where all had to that point was gas and it was having no effect. I did feel very drowsy for about 2 hours (I was so exhausted it was actually a nice feeling) but no other side effects. My daughter cried instantly when born, scored 10 on Apgar scale and latched pretty much straight away. She's now 3 months old, no health issues and I'm still breast feeding with no probs. I think all medications effect people in different ways but you have to do what best for you at that time.

Hi I had the pethidine injection when I gave birth to my first child 12 days ago. The injection was in my right thigh. Is it normal to have an achy type pain in my right thigh when I bend down on me knees or is it possible it caused deep vein thrombosis? Does the injection bruise the muscle? How long does it last?

Hi, i had pethidine while i was in labor and im just wondering if anyone has had side affects with their tongue? Mine seems to be very numb or the feeling in it seems to be different, sounds strange i know.. also i seem to have developed a small bit of a lisp. Please help!

I have had pethidine for 2 out of 3 of my births so far, and intend on having it for this birth as well. I would rather have pethdine than an epidural. None of my children have asthma problems - and it runs in our family. Can I just say that for those who were not told before hands that it could have these effects, that is probably because there has been no research done to this, so midwives/doctors can only tell you the facts. And if it is an issue, it is up to you to do the research before you get to that point so you know all the risks, and put it in your birthplan and discuss it with your partner.

I was given pethidine just 35 minutes before my baby was born. The midwife thought things were going to take much longer but soon after i had the injection my waters broke and i gave birth very quickly. The pethidine resulted in my baby needing to be resuscitated and me feeling so out of it that i couldnt understand what was happening to him. Once he was breathing he was very very sleepy and unable to latch on because of this. He couldnt feed at all and ended up losing12% of his body weight.
My advice would be not to touch it. Although i know people who have had it and loved it, i wasnt told at the time that it was potentially dangerous for my baby. Even if the midwives give it to you thinking you are in the very early stages of labour nobody knows how quickly things could speed up. For the very little relief it gave me from the pain it was certainly not worth the trauma of watching my baby being resuscitated.

I used pethadine while in labour and i wont be using it during my next as it made my babies heart beat drop, which scared the crap out of me! But baby came out fine and is now 3 with no problems. I also didnt find it to help with pain either.

My experience with pethadine was quite good. While it didn't exactly take the pain away, it sedated me enough to get some sleep. I think it also assisted the induction by helping open my cervix a bit faster. 4 hours of contractions, had the pethadine, slept for the majority of the next 3 hours then boom baby was born :)

Pethidine was given to me at the age of seventeen when i was in labour. i wasn't asked if i needed or wanted it. It was just administered to me, i was too young to question what it was. My pain was so severe i passed out several times, i had severe hallucinations, i was sick and drugged up. my son was born normal and healthy. However 20 years later he developed a serious addiction to heroin and i believe it is because i was given this drug during labour. I firmly believe this to be the case and in years to come it will be proved. after all pethedine is the same form of pain relief as heroin and morphine.

OMG I totally agree that I should have been informed about the possible side effect to the baby. Like a few of you have mentioned my son is now 14 yaers old and the exact same senario as Susan and Christine, he has respiratry issues when he gets a cold in addition to asthma and wheezing during those times. I am really upset. I had no idea nor was I told of the possible effects. As far as the no long term studies, well it seems that this is evidence of long term effects.

I had high blood pressure when I was pregnant and was given pethedine at 34 -35 weeks pregnant ( and during the birth). I remember the doctors arguing at my bedside about the amount I was being given. My son is now grown up but has always been very anxious and suffered from depression. Is there any evidence that pethedine can affect development of a baby at that stage? I was induced at 36 weeks.

I was given pethidine about 1 hour before the birth of my second child. She is now 8 and healthy, however she has the exact same respiratory / asthma type wheezing (as susan and christine)every time she gets a cold.
We have no other asthma symptons in our family.

just reading the comments about pethidine and breathing/asthma problems later in life.i had an induction for my first baby so epidural was the only pain relief needed obviously and my daughter who is now 9 has no asthma problems and hardly ever gets sick.had my son 20 months later and i was given pethidine during labour, my son was a big baby 10,9oz but has suffered asthma problems ever since and been hospitalised for it aswell.there is no one else in the family with any breathing problems.i cannot help but think now after reading all this that his problems are due to the pethidine.! i am 25 weeks pregnant with my third child and was wanting pethidine for this labour as it was effective in distancing me from the pain but now am not going to even consider it.any other suggestions would be greatly appreciated.

I had no pethidine for my first child but did use gas, and was a good birth with no complications. My second birth I used gas and then later on had pethidine, I also was unaware of side affects to my baby. I personally found pethidine not to be a good experience because it made me nauseus and extrememly drowsy in between contraction to the point of sleeping and I feel like I missed the labor. I became so sleepy. I would not use it again. At the time it was a split second descision as yes childbirth is painful. However I would really reccommend having a very supportive bith partner: if hubby or boyfriend cat hack it then bring a girlfriend! The support makes all the difference and helps you stay strong which in turn reduces the amount of intervention needed. Thanks.

Hi, I was induced and had pethidine 30-40 minutes before my baby was born as I was only 4cms at the time and they thought I still had a long time to go ...the nurses said it wouldn't of went through to him but I'm worried that it might of. Do you know if it would of and they actually didn't want to worry me? He was born completely in still and in shock, they rushed him away and gave him oxygen (which I only just found out) a couple times to get him breathing then kept checking on him the next couple of days. He has always breathed fast, he had slight jaundice the first week and has had a persistant cough since birth. He also has had on and off reflux since birth..that bad that i've had to change his clothes up to 15 times in one day. Sometimes it's normal vomiting sometimes it's projectile (just recently it has become worse and am taking him to the hospital) could this have anything to do with it?
I'm a bit worried and no one seems to have any answers or much knowledge about it ..he's 4 months old and he's had all these problems since birth. As well as a hernia, which they said isn't a dangerous one...

For those saying they didn't know about the side effects, did you not attend the post natal classes at your hospital or do any research prior to giving birth? This information is readily available and you'd be best to review these things when in the right frame of mind instead of at a point when you are in immense pain

I had a pethidine injection 2 hours after my waters broke and had my baby 3 hours later. I think it was great I fell asleep until I had to push so I wasn't tired and was able to push my baby out rather quickly. I would use it again for sure my baby had no problems after birth and neither did I :)

i had an induced svd a week ago, and had pethidine inj i.m just an hour before i become fully dilated, after i delivered my baby boy he did not cry i was so scared, they try to stimulate my baby given narcan as antidote and done resuscitation, at last i heard my baby cry but weak. he is sucking very well up to this time but i noticed episode of increase respiratory rate and wheezing sound while breathing..i am so alarmed what will pethidine cause to my first baby..i just think why give this drug if it will be harmful to the baby anyway? pls help..what should i do. based on what i read in above stories, is there any thing we can do to prevent the future side effects of this drug??

My daughter was born 24 years ago. I was administered Pethidine just prior to giving birth to her. She stopped breathing and we initially thought we had lost her. I was told afterward that she had been affected by the drug whilst still I was giving birth. She has Dyspraxia which I believe was caused by this nasty drug. No one asked me if I wanted the drug. I was just administered it . The day after giving birth my GP told me I was given twice the amount that I should of had. I feel so sad as she is so beautiful but she has so many difficulties which is truly heartbreaking.

My son was born 23 years ago. I too was administered Pethidine about 20-30mins before giving birth to him, despite refusing to have it. the midwife did so on my husbands say so. It did nothing for the pain, just made me feel spaced out and I unable to tell them I was in agony. I really do not remember much of the birth, other than that my son was rushed straight out of the room. My husband told me he wasn't breathing and needed some time in an inqubator. he did have jaundice and seemed to have a constant cold while growing up. very much like ruth's daughter he was diagnosed with ADHD(attention deficit and hyperactivity disorder)he's on the autistic spectrum, has OCD and borderline oppositional defiance disorder. I often wondered if the pethidine so close to birth could have caused these problems. I knew very early that something wasn't right, he spent a lot of time looking around and never really slept much, he didn't reach certain developmental milestones, but everytime i mentioned it to health visitors or as he got older school they blamed us and said we needed to read more with him etc. what upsets me most is having specifically told the midwife no, she ignored my instructions and went ahead to give me the pethidine on my husbands say so. there are a lot of what if's in my mind. I do think that more research needs to be done into the effects of pethidine on the baby, specially in the long term.

I was given pethidine in 1970s, I did not know at that time it was being used in several hospitals as a trial. I had the max injections in the minimum time as my labour was so painful. The midwives in the hospital could tell my baby was having trouble coming towards the end & said baby was in difficulty & I had to get it out as soon as possible. Once born baby had trouble breathing & doctor wheeled in a suction apparatus trolley & used suction to get out mucous in baby's throat. Still nothing until few minutes later baby cried. As was tiny child rushed to prem unit although not premature weight, just under 6 lb. Then I was told Baby had difficulty in sucking but after a while was OK.

After a year I was concerned about child's progress, slower than most children. Queried it several times over the years but was told once at school would catch up. Well not so. child diagnosed as having learning difficulties. Had to go to special schools & still having help through a charity for difficult learners.

About 20 years ago I heard on radio programme which was discussing this painkiller that a survey found many children whose mothers had large dose of pethidine during labour had learning problems. Some tried to sue the company but had not got very far. I met a lady, about 10 years ago, who had similar problems with her child. She was given large dose of pethidine during labour & he was very backward as he had not had enough oxygen for the first few minutes of his life. Needed constant care & supervision even in his 30's. This lady is the only person who I got to know who had same problems as me. I told her what I had heard on the radio & she agreed with me, the drug must have affected our babies.

Hi, not sure if anyone has had this but I had pethidine nearly 7 years ago in my left thigh when I had my daughter, since then the area has been numb and has a tingling sensation in it. I then had it again last October with my other daughter in my right thigh and now that is still numb and tingly. Does anyone know if this ever goes away? Thanks

In 1980 I was coping with my labor pains ok until the nurse artificially broke my waters. After that I experienced nausea, as that is how my body registers pain. The nurse insisted that they give me "a little something for the nausea", and I said, no I didn't want anything, because I was worried about the effects of drugs on my baby. They assured me it was just an anti-nausea drug then they injected me with Pethidine. I hallucinated and passed in and out of consciousness for twelve hours. It was terrible, like being in purgatory. When I gave birth, my son was blue. I instinctively knew he was hypoxic and I told the staff to give him oxygen and make him warm before handing him to me. He had a rare form of dyslexia, hyperactivity, and delayed onset of speech. His IQ for comprehension is above average but he still suffers from anxiety, asthma, poor sleep patterns, and problems with spelling and writing. There is a reason so many countries now forbid the use of this drug in labor. So much needless suffering and the imposition of disability on innocent lives. I had a natural birth 8 years later and the difference was phenomenal. I got up and showered after the birth and felt blissed from my natural endorphins. Think twice then think again before agreeing to this drug during labor.

I had pethidine very close to giveing birth and my baby girl came out blue and unable to breath. She was rushed to the neonatal unit and had many wires attached to her and breathing apperatus we got told she would have brain damage due to lack of oxygen. She is now out of hospital but has asthma like symptoms. If i was told about the possible danger for my baby i would never have taken it.

I had pethidine very close to giveing birth and my baby girl came out blue and unable to breath. She was rushed to the neonatal unit and had many wires attached to her and breathing apperatus we got told she would have brain damage due to lack of oxygen. She is now out of hospital but has asthma like symptoms. If i was told about the possible danger for my baby i would never have taken it.

Oh my gosh! I am shocked to see so many comments about children having been diagnosed with dyspraxia /ataxia, adhd,autism and the like! I was given pethadine during labour & my son reacted badly, heart rate dropping, becoming very lazy, when he was born he struggled to breathe & turned blue, he is now 13 & suffers from all the above conditions! Surely more research needs to be done! I toobwas not told of any possible side affects related to this drug.

I too had the pethidine and had it twice as I was in labour for 30 odd hrs, I had read up on all the different drugs but never read on side effect to the child even in birthing classes all that was expressed was that it was ok to have pain relief during labour. Finally my son is born with apgar score of 1 purple not breathing rushed to intensive care where he stayed for 5 day all the while I was made to feel like I has to express milk day in day out till my breast became the size of hard watermelons whilst feeling depressed the nurses only cared about was breast feeding. 10yrs on and my son has AUTISM without a shadow of a doubt in my mind this was due to the pethidine.